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Introduction: Soft skills are the hallmark of a master healthcare provider. One of the most effective ways to teach soft skills to healthcare providers is through service-learning. Evidence suggests that adding simulation as part of a service-learning team’s pre-departure training (PDT) will better prepare them to resolve ethical and cultural dilemmas often encountered in resource-limited countries, plus facilitate soft skills. We hypothesized that simulation could improve soft skills of physical and occupational therapy students and clinicians providing rehabilitation services on a one-week service-learning experience in Guatemala.

Methods: A convenience sample of 21 physical and occupational therapy students and clinicians who participated in four 1-hour PDTs were included in this qualitative study using grounded-theory methods. Training consisted of didactic, reflective and simulation components designed to introduce self-awareness, team-building, cultural knowledge, and to support trip preparations. Four debriefings were recorded using open-ended questions with a thematic approach around the concepts of preparedness and cultural adaptability, which represented the dependent variables. The independent variable was a 20-minute simulation emphasizing cultural and socio-emotional challenges of the host community.

Results: Six themes emerged: confidence, empathy, communication, mentorship, self-knowledge, and cultural competency. The themes described were core elements of empowering the participants towards advocacy and process improvement. As a result of the simulation experience, participants in this study were better able to respond to distressing situations encountered on site, and they expressed the service-learning experience, supported by the PDT simulation, stirred significant maturation.

Discussion and Conclusion: Simulation is useful for developing self-regulatory skills, especially in response to culturally novel, emotionally-charged situations. Simulation for enriching international service-learning experiences is recommended as best practice to prepare healthcare providers in facing ethical and cultural demands of resource-limited countries.


This is the final publisher's version of the article published May 2, 2019 in MedEdPublish:

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